The impact of culture on psychotherapy: Korean clients' expectations in psychotherapy.

The impact of culture on clients' expectations for psychotherapy has not been adequately studied. This is the first study to explore Korean clients' expectations in psychotherapy. A 120-item instrument was used to collect data on expectations for psychotherapy held by 25 Korean clients of the Asian Mental Health Clinic. Six hypotheses regarding expectations for therapist's discipline, characteristics, techniques, goals, and roles in psychotherapy were examined. The findings indicate that the model that Koreans have for a psychotherapeutic relationship is similar to the special teacher-disciple relationship in Korea. The study demonstrated that psychiatric nurses are held in high regard by Korean clients. Education of Koreans to Western psychotherapy concepts and procedures is essential. Recommendations were made for different treatment modalities integrating Western concepts of psychotherapy with Korean cultural concepts of mental health.     

Using mindfulness-based therapeutic interventions in psychiatric nursing practice--part II: Mindfulness-based approaches for all phases of psychotherapy--clinical case study

Finding effective nursing interventions for the treatment of mental illness is a major concern for advanced practice psychiatric nurses (APPN). Increasingly, innovative psychotherapeutic treatment modalities are being used for the treatment of individuals with serious mental illness. One such innovative approach, Mindfulness-based therapeutic interventions, has been shown to relieve distress for individuals with medical and psychiatric illnesses. In Part I of this two-part article, the authors described principle concepts of mindfulness, reviewed current research in the usefulness of mindfulness practice for treatment of psychiatric illnesses. The structure and content of mindfulness-based cognitive therapy (MBCT) was also outlined and provided the theoretical basis for this treatment approach. This alternative therapeutic approach offers potential usefulness for the treatment of individuals suffering from mental illness. Part II of this article presents a more detailed explanation of mindfulness-based therapeutic approaches for all phases of psychotherapy and identifies relevant research questions that will provide an empirical base to guide clinical practice. A case study illustrates mindfulness-based therapeutic interventions.     

Brain‐based treatment—A new approach or a well‐forgotten old one?

For a relatively long period of time, mental functioning was mainly associated with personal profile while brain functioning went by the wayside. After the 90s of the 20th century, or the so called “Decade of the Brain”, today, contemporary specialists work on the boundary between fundamental science and medicine. This brings neuroscience, neuropsychology, psychiatry, and psychotherapy closer to each other. Today, we definitely know that brain structures are being built and altered thanks to experience. Psychotherapy can be more effective when based on a neuropsychological approach—this implies identification of the neural foundations of various disorders and will lead to specific psychotherapeutic conclusions. The knowledge about the brain is continually enriched, which leads to periodic rethinking and updating of the therapeutic approaches to various diseases of the nervous system and brain dysfunctions. The aim of translational studies is to match and combine scientific areas, resources, experience and techniques to improve prevention, diagnosis and therapies, and “transformation” of scientific discoveries into potential treatments of various diseases done in laboratory conditions. Neuropsychological studies prove that cognition is a key element that links together brain functioning and behaviour. According to Dr. Kandel, all experimental events, including psychotherapeutic interventions, affect the structure and function of neuronal synapses. The story of why psychotherapy works is a story of understanding the brain mechanisms of psychic processes, a story of how the brain has been evolving to ensure learning, forgetting, and the mechanisms of permanent psychological change. The new evidence on brain functioning necessitates the integration of neuropsychological achievements in the psychotherapeutic process. An integrative approach is needed to take into account the dynamic interaction between brain functioning, psyche, soul, spirit, and social interaction, ie, development of a model of psychotherapeutic work based on cerebral plasticity! Brain‐based psychotherapy aims at changing brain functioning not directly, but through experiences. This is neuro‐psychologically informed psychotherapy.     

Application of a context-oriented model for the planning of psychotherapy

Since clinical experience has shown that creating a therapeutic setting with borderline or psychotic patients is extremely difficult the Department of Psychoanalysis and Psychotherapy at Vienna University Hospital has developed a method of treatment designed to increase the possibilities to work with this group of patients. This procedure is conceptualised as "context oriented model exploration in psychotherapy planning" COMEPP. Initially the context is explored in which the psychotherapeutic model should be implemented which has so far failed for different reasons. Following this a setting is created in which the therapeutic team and the patient(s) can constructively and creatively reflect on alternative therapeutic models. A clinical case illustrates the problems and the basic structure of COMEPP in a schematic and condensed form.     

Psychology in medical rehabilitation

Integral cooperation of a clinical psychologist or psychotherapist in an internal medicine rehabilitation clinic is required because the presence of (contributory) psychic causes is evident beyond any doubt in numerous complaint syndromes. Regrettably, decision-making bodies frequently fail to acknowledge the necessity of competent psychological help. Various activities have developed as specific psychotherapeutic tasks, among them individual interviewing and above all group work (client-centered psychotherapy, staff-client meetings, health education, autogenic relaxation training, creativity therapy, biofeedback, and so on). Client-centered psychotherapy indications are outlined. Medical psychology, psychotherapy, and psychosomatic aspects of disease concepts must not be ignored if major concerns in medial rehabilitation and inpatient rehabilitative treatment programmes are to be dealt with effectively.     

Taking a history of childhood trauma in psychotherapy : achieving an optimal approach

The authors examine the process of taking an initial history of childhood abuse and trauma in psychodynamic psychotherapy. In exploring the advantages, complexities, and potential complications of this practice, they hope to heighten the sensitivities of clinicians taking trauma histories. Emphasis on the need to be active in eliciting important historical material is balanced with discussion of concepts that can help therapists avoid interpersonal dynamics that reenact and perpetuate the traumas the therapy seeks to treat. Ensuring optimal psychotherapeutic treatment for patients who have experienced childhood trauma requires attention to the following concepts: a safe holding environment, destabilization, compliance, the repetition compulsion, and projective identification.     

Communication skills in an aphasic deaf adult

A case study is presented of a 64-year-old, right-handed, congenitally deaf man who suffered a single, unilateral, left CVA resulting in a right hemiplegia and moderate aphasia. The relationship between his verbal (reading and writing), manual, and pantomimic performances is examined in two ways. First, a comparison of the three modes of communication shows whether or not these systems can be dissociated by pathology. Second, the extent to which one mode recovers more fully than the others indicates whether the three modes function independently. Results of testing conducted at six weeks and at 18 months postonset revealed that this individual's manual, verbal, and pantomimic communication skills were all similarly impaired as a result of his CVA. Furthermore, at 18 months no single mode had recovered more rapidly or to a greater extent than any other. These results support the notion that aphasia in the deaf and hearing population is similar, and is consistent with the view that aphasia is the result of a central symbolic/cognitive process which manifests itself in parallel dysfunctions of verbal, manual, and pantomimic communication.     

Combining therapeutic approaches.

It would seem on the surface that psychotherapeutic approaches as different as psychoanalysis and behavioral therapy have little in common. In fact, they seem to be similar in terms of expectation of help, nonconfirming experiences, informational learning, changes in self-concept, reinforcement/influence, paradox, and problem solving. Therapists who work with clients who present life-threatening symptoms, self-reinforcing cycles, and/or therapeutic engagement difficulties may do well to consider ways to combine therapeutic approaches in order to deal with these sticky therapeutic problems.     

Practice of psychotherapy for cancer patients

Cancer is a threat to life and to the psychological well-being of patients. Previous studies have demonstrated that several patients with cancer have suffered from psychological distress. Psychotherapy for cancer patients is effective against psychological distress. There are several kinds of psychotherapy for these patients, such as supportive psychotherapy, cognitive behavioral psychotherapy including relaxation techniques and cognitive restructuring, and supportive-expressive group psychotherapy. Supportive psychotherapy is feasible for many clinicians. Psychotherapists develop a trustful relationship with patients, provide an empathic posture, and use various types of psychotherapeutic treatments. It is important for psychotherapists to understand the psychological background of such patients from various viewpoints.     

Group psychotherapy and patients with cognitive impairment

Patients with cerebral insult and resultant cognitive deficit form a growing but often neglected population, who may benefit greatly from increased psychological input. Relatively little information exists on group psychotherapy within the cognitively impaired population and there are few published guidelines on how best to meet the psychological needs of this complex and varied group of patients. By combining the common sequelae of cerebral insult, well established principles of group therapy and personal experience, this article highlights the numerous difficulties and dilemmas encountered in group psychotherapy with a cognitively impaired population and draws on the available group therapy literature in an attempt to provide some insight and possibilities for the future.     

Phototherapy in the context of psychotherapy

Phototherapy, or treatment with bright artificial light, has been used to treat seasonal affective disorder and related conditions. Using the cases of two patients who were treated with both psychotherapy and phototherapy, the author explores the potentially powerful psychotherapeutic aspects of this new treatment. Within a therapeutic relationship, light has a rich symbolism, and it may serve as an inanimate symbol of the therapist. Perhaps because of the lack of well-established guidelines or traditions regarding its use within psychotherapy, however, light treatment can lead to the violation of the usual boundaries of treatment. If this danger is avoided, phototherapy may be a powerful adjunct to psychotherapy.     

Special needs of the deaf dying patient

Hospice and hospital personnel who give care to dying patients should be prepared for situations in which a client or family member is hearing impaired. What are the specific concerns of a hearing impaired client? How are needs for meaningful conversation and expression of feelings compromised by the care giver's awkwardness? This article provides practical suggestions for meeting needs of hearing impaired clients with serious illnesses.     

A peer-led HIV counselling and testing programme for the deaf in Kenya

Purpose. To describe and evaluate the establishment of the first VCT services for the Deaf in Africa.

Method. Operational research methods were used to document programme establishment. The demographics of deaf VCT clients were compared with hearing clients at the same sites as well as where clients had learned of the service, HIV risks, and HIV test results. Univariate and multivariate analyses were used.

Results. During the two year period (January 2004 to December 2005) 1709 Deaf and 1649 hearing clients were seen at three Deaf VCT sites. The majority of Deaf clients in this sample learned of the services through the peer education programme. Data indicate that Deaf VCT clients are as much at risk of HIV from sexual transmission as their hearing counterparts and that Deaf persons seeking VCT services have an HIV prevalence of 7%, similar to the national rate of 6.7%.

Conclusions. The Deaf in Kenya are at risk of HIV and there is an urgent need for Deaf-friendly HIV services, supplemented by peer education programmes. This is the first published report describing HIV services run by the Deaf for the Deaf in the developing world.     

Cognitive therapy integrated with life review techniques: an eclectic treatment approach for affective symptoms in older adults

Background. An important aspect of nursing theory development has been the adaptation of theory from other disciplines within the metaparadigm of nursing. This eclectic approach to theory development enhances the broad humanistic theory base on which effective, professional nursing practice is based. Aims and objectives. The aim of this article is to describe the process of integrating two distinct psychotherapeutic approaches into one coherent mental health nursing intervention for the treatment of affective symptoms in older adults. Guidelines for using this integration process in psychiatric mental health nursing clinical practice are presented and illustrated through the case study approach. Methods. A case study is presented describing a clinical situation in which life review techniques were used to enhance the outcomes of a cognitive therapy experience for older adults enrolled in outpatient psychotherapy treatment for acute adjustment disorder with an affective component. Conclusions and relevance to clinical practice. The advanced practice psychiatric mental health nurse who approaches psychotherapeutic interventions with older adult clients from an eclectic approach can achieve successful outcomes by having a clear understanding of (i) the dynamics of the various psychotherapeutic approaches, (i) the skill level of the practitioner, (iii) the psychosocial sophistication of the client, and (iv) the pathology being treated. In addition, active involvement by the client in a treatment process that matches his/her psychosocial skill and coping resource level will contribute to effective resolution of pathology. A cognitive therapy approach supplemented by life review techniques is an excellent example of an effective, eclectic treatment approach of affective disorders in older adults.     

A non-expert-user interface for posing signing avatars

We describe a graphical user interface designed to allow non-expert users to pose 3D characters to create American Sign Language (ASL) computer animation. The interface is an important component of a software system that allows educators of the Deaf to add sign language translation, in the form of 3D character animations, to digital learning materials, thus making them accessible to deaf learners. A study indicates that users with no computer animation expertize can create animated ASL signs quickly and accurately.

Implications for Rehabilitation

• Deaf education, especially in science, technology, engineering and math (STEM), is a pressing national problem in the U.S. Deaf individuals are significantly underrepresented in STEM fields.

• An important underlying cause of the educational lag is that young deaf students have limited access to grade-level curriculum materials (because of their low English literacy level).

• Computer animation of American Sign Language (ASL) has the potential to improve learning outcomes by making educational content deaf accessible, thus providing deaf children with the same learning opportunities as hearing students.

• The work reported in the paper shows that it is possible for deaf educators, who are not animators, to annotate digital lessons with ASL translation in the form of animated avatars, thus making them accessible to deaf children.

     

Preferences for communication in clinic from deaf people: a cross‐sectional study

Aims and objectives To explore the preferences of deaf people for communication in a hospital consultation. Methods Design – cross‐sectional survey, using a structured, postal questionnaire. Setting – survey of readers of two journals for deaf and hard of hearing people. Participants – 999 self‐selected individuals with hearing loss in the UK, including those who use sign language and those who use speech. Main outcome measures – preferred mode of communication. Results A total of 11% of participants preferred to use sign language within everyday life, 70% used speech and 17% used a mixture of sign and speech. Within a clinic setting, 50% of the sign language users preferred to have a consultation via a sign language interpreter and 43% indicated they would prefer to only have a consultation directly with a signing health professional; 7% would accept a consultation in speech as long as there was good deaf awareness from the health professional, indicated by a knowledge of lip‐reading/speech‐reading. Of the deaf speech users, 98% preferred to have a consultation in speech and of this group 71% indicated that they would only accept this if the health professional had good deaf awareness. Among the participants who used a mixture of sign language and speech, only 5% said they could cope with a consultation in speech with no deaf awareness whereas 46% were accepting of a spoken consultation as long as it was provided with good deaf awareness; 30% preferred to use an interpreter and 14% preferred to have a consultation directly with a signing health professional. Conclusions The hospital communication preferences for most people with deafness could be met by increasing deaf awareness training for health professionals, a greater provision of specialized sign language interpreters and of health professionals who can use fluent sign language directly with clients in areas where contact with deaf people is frequent.     

Beyond Carl Rogers: The Work of David Grove

This article is written with the belief that psychotherapy can be enriched by the addition of ideas from anthropology and holistic health care. This paper introduces the psychotherapy of David Grove. The paper tries to re-emphasize the need for therapists, or healers of all kinds, to be aware of the language, therapeutic structure and experience of clients. Clients' experiences are more fully understood in the context of greater awareness of the inter-relationships of language, experience, belief, enculturation and communication. Such awareness is posited as being crucial to holistic practitioners. Holistic psychotherapy regards people as living in culture; human qualities as living in people; and seeks to create healing experiences for clients by studying communication between real people. The case for a phenomenological therapy is put forward.